<style type="text/css">
    body {
        padding-top: 40px;
        padding-bottom: 40px;
        background-color: #f5f5f5;
    }

    .form-signin {
        max-width: 300px;
        padding: 19px 29px 29px;
        margin: 0 auto 20px;
        background-color: #fff;
        border: 1px solid #e5e5e5;
        -webkit-border-radius: 5px;
        -moz-border-radius: 5px;
        border-radius: 5px;
        -webkit-box-shadow: 0 1px 2px rgba(0,0,0,.05);
        -moz-box-shadow: 0 1px 2px rgba(0,0,0,.05);
        box-shadow: 0 1px 2px rgba(0,0,0,.05);
    }
    .form-signin .form-signin-heading,
    .form-signin .checkbox {
        margin-bottom: 10px;
    }
    .form-signin input[type="text"],
    .form-signin input[type="password"] {
        font-size: 16px;
        height: auto;
        margin-bottom: 15px;
        padding: 7px 9px;
    }

</style>
<div class="container-fluid">
    <div class="container">
        <form method="POST" action="" class="form-signin">
            <h2 class="form-signin-heading">Register Form</h2>
            <?php include 'views/Include/alert.php'; ?>
            <input type="text" name="username" class="input-block-level" placeholder="User Name" required>
            <input type="password" name="password" class="input-block-level" placeholder="Password" required>
            <input type="password" name="re-password" class="input-block-level" placeholder="Re-Password" required>
            <hr />
            <input type="text" name="fullname" class="input-block-level" placeholder="Full name" required>
            <input type="text" name="phone" class="input-block-level" placeholder="Phone number" required>
            <input type="email" name="email" class="input-block-level" placeholder="Email address" required>
            <input type="text" name="adress" class="input-block-level" placeholder="Address" required>
            <select name="gender"> 
                <option value="0">Male</option>
                <option value="1">Female</option>
            </select>
            <input type="hidden" name="assign_id" class="input-block-level" placeholder="Assign" value="1">
            <input type="hidden" name="role_id" class="input-block-level" placeholder="Role" value="1">
            <input type="hidden" name="insert_date" class="input-block-level" placeholder="Address" value="<?php echo date('Y-m-d H:i:s');?>">
            <input type="hidden" name="update_date" class="input-block-level" placeholder="Address" value="<?php echo date('Y-m-d H:i:s');?>">
            <input type="hidden" name="status" class="input-block-level" placeholder="Address" value="0">

            <button type="submit" class="btn btn-large btn-primary">Sign in</button>
        </form>
    </div> <!-- /container -->
</div>
